National Post (National Edition)
COVID-19 seeps back into nursing homes
Outbreaks across the country
In the spring wave, Dr. Amit Arya was part of a long-term rapid action response team sent into homes hit by horrifying COVID outbreaks. A palliative care doctor, Arya saw residents who were gasping for air, whose oxygen levels had plummeted and who clearly had COVID-19 and were dying “and no one was there to provide the proper care, or look after them.”
“I’ ll just be very open with you. It’s still something I think about every day. It haunts me. I wish I could have done more,” she said in an interview.
As a rash of new infections seeps back into long-term care homes, Arya fears more similarly horrendous scenes. Despite promises to protect the vulnerable this time around, COVID-19 is shifting, from the highest case numbers in the 20 to 39 age group over the summer, to increasing cases in older people. Canada’s chief public health officer warned this weekend about a growing number of outbreaks in long-term care.
“While these outbreaks involve a smaller number of cases than in April and May, we know that spread in these facilities often leads to death,” Dr. Theresa Tam said, with considerable understatement. The spring wave claimed more than 9,100 lives, with outbreaks in longterm care and retirement homes accounting for 75 per cent of all COVID-19 deaths in the country.
As of Monday, there were active outbreaks in 58 longterm care homes in Ontario, with 40 COVID-19 deaths in the past month. On Sunday, federal Public Safety Minister Bill Blair tweeted that the Red Cross was being sent into seven Ottawa-area homes to help “asses and stabilize the situation.” In Edmonton, 53 residents and 27 staff have tested positive for the virus at the Millwoods Shepherd’s Care Centre; seven residents have died.
Outbreaks have been reported in Quebec, New Brunswick, B.C. and Alberta long-term care homes. Last week, an interim report from Ontario's patient ombudsman told of reports of COVID-19 positive staff forced to come to work, and staffing shortages that were making it difficult to provide even the most basic care.
We blundered, appallingly, on the long-term care front in Ontario and Quebec in the first wave, experts say. We crushed the curve and contained community spread, but forced the infection into understaffed, ill-prepared, long-term care homes. There were more than 840 outbreaks. Military sent into Ontario and Quebec nursing homes found residents unwashed, dehydrated and, in some cases, dead. The “once-in-acentury” pandemic laid bare the deadly deficiencies dozens of studies and advocates had warned of for decades while so many governments averted their eyes. Now some worry, will the scenarios of the spring be repeated?
“If we think back to those early days in February and March, what we were all worried about was a scenario like Italy and New York,” said Arya, who has appointments at the University of Toronto and McMaster University in Hamilton. “A lot of the focus was on protecting acute care — acute care hospitals, making sure we had enough ventilators. Some of those fears are coming back, and rightfully so. But we also have to do all we can to protect long-term care.”
It's not surprising outbreaks in care homes are increasing. “These homes are not on separate islands,” Arya said. The more transmission in the community, the greater the risk of COVID-19 being carried into a home.
In June, Quebec promised an additional 10,000 “orderlies,” or personal support workers, by September. According to CTV News, just over 7,100 are in place.
In B.C., where Canada's first reported COVID-19 related death involved a man in his 80s, a resident at the Lynn Valley Care Centre in North Vancouver, the province moved quickly. Health workers were limited to a single home. The province promoted a system of fulltime work, standardized wages and sick leave. “We know from the first wave it was health workers who unknowingly spread the virus,” Arya said. Long-term residents were also nearly three times more likely to live in shared rooms in Ontario than in B.C., according to a recent study.
As of Sept. 10, Ontario had reported 1,817 resident deaths from COVID-19 in long-term-care homes, compared with 156 deaths in B.C. homes.
Ontario recently announced a $3 per hour wage boost for personal support workers, one dollar less than the old $4 per hour pandemic subsidy. The province has also announced half a billion in additional support, including a greater supply of personal protective equipment, testing workers, improved infection control and repairs and renovations. Homes have also been directed to stop admitting people to rooms of three or four. But it didn't address the people already living in multiple-bed rooms.
“It's unsurprising to me, sadly, that we're having outbreaks in long-term care homes,” said Dr. Nathan Stall, a geriatrician with Sinai Health System and Toronto's University Health Network who believes that the second wave started somewhere around the beginning of September.
“And since that time we've continued to accumulate two to three long-term care homes a day that are going into outbreak. Because who works in long-term care homes? They're people who don't live in long-term care homes. They come from the community where the transmission is high, and they are going to become infected themselves by living in the community and unknowingly import the virus” into care homes.
We need to think about creating additional space, like field hospitals, Stall said.
“What happened in the spring was truly a humanitarian crisis,” he said. “If we do not create emergency response plans that include things like this, the same level of catastrophe will happen again.”
HAVE TO DO ALL WE CAN TO PROTECT LONG-TERM
CARE.